Rural Pass Through Legislation - American Society of Anesthesiologists (ASA)

Many states face ongoing challenges in assuring access to medical care services for their citizens living in rural areas. Insufficient Medicare payments and low patient volume have made it particularly difficult for many rural facilities to attract and retain qualified health care providers. In response to these challenges, Congress has enacted a variety of incentive programs to encourage providers to practice in rural areas.

One such program is the anesthesia rural “pass-through” program – a program created as an incentive for anesthesia providers to practice in small rural hospitals. Under the “pass-through” program, eligible hospitals may use reasonable-costs based Part A payments in lieu of the conventional Part B payments as a rural practice inducement for non-physician anesthesia providers such as anesthesiologist assistants (a type of physician assistant) and nurse anesthetists to practice in small, low volume rural hospitals. Under the Centers for Medicare and Medicaid Services (CMS) current interpretation of the current “pass-through” program, eligible small rural hospitals are not permitted to use the “pass-through” funds to hire physician anesthesiologists. Changes are necessary to expand rural access to the services of physician anesthesiologists.

In 2010, the American Society of Anesthesiologists, through formal comment, requested that CMS permit rural hospitals to use the rural pass-through arrangement for anesthesiologists, as well as the other providers. CMS responded that it cannot permit hospitals to use the pass-through arrangement for anesthesiologists without a change in the current law.

Congresswoman Lynn Jenkins (R-KS-02), Congressman Emanuel Cleaver (D-MO-05) and Congressman John Moolenaar (R-MI-04) introduced the bipartisan Medicare Access to Rural Anesthesiology Act which would reform the program and allow rural hospitals to use already available “pass-through” funds to employ or contract with all types of anesthesia providers – physician anesthesiologists, as well as anesthesiologist assistants and nurse anesthetists. ASA strongly supports this legislation.

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